Concurrent brain-responsive and vagus nerve stimulation for treatment of drug-resistant focal epilepsy.
Epilepsy & behavior : E&B
washington; swedish; swedish neuro; Complications; Drug-resistant epilepsy; Neuromodulation; Responsive neurostimulation; Seizure outcome; Vagus nerve stimulation; Adult; Brain; Drug Resistant Epilepsy; Epilepsies, Partial; Humans; Retrospective Studies; Treatment Outcome; Vagus Nerve; Vagus Nerve Stimulation
OBJECTIVE: Clinical trials of a brain-responsive neurostimulator, RNS® System (RNS), excluded patients with a vagus nerve stimulator, VNS® System (VNS). The goal of this study was to evaluate seizure outcomes and safety of concurrent RNS and VNS stimulation in adults with drug-resistant focal-onset seizures.
METHODS: A retrospective multicenter chart review was performed on all patients with an active VNS and RNS who were treated for a minimum of 6 months with both systems concurrently. Frequency of disabling seizures at baseline before RNS, at 1 year after RNS placement, and at last follow-up were used to calculate the change in seizure frequency after treatment. Data on adverse events and complications related to each device were collected.
RESULTS: Sixty-four patients from 10 epilepsy centers met inclusion criteria. All but one patient received RNS after VNS. The median follow-up time after RNS implantation was 28 months. Analysis of the entire population of patients with active VNS and RNS systems revealed a median reduction in seizure frequency at 1 year post-RNS placement of 43% with a responder rate of 49%, and at last follow-up a 64% median reduction with a 67% responder rate. No negative interactions were reported from the concurrent use of VNS and RNS. Stimulation-related side-effects were reported more frequently in association with VNS (30%) than with RNS (2%).
SIGNIFICANCE: Our findings suggest that concurrent treatment with VNS and RNS is safe and that the addition of RNS to VNS can further reduce seizure frequency.
Neurosciences (Brain & Spine)
Brown, Mesha-Gay; Sillau, Stefan; McDermott, Danielle; Ernst, Lia D; Spencer, David C; Englot, Dario J; González, Hernán F J; Datta, Proleta; Karakis, Ioannis; Becker, Danielle; Rolston, John D; Arain, Amir; Rao, Vikram R; Doherty, Michael J; Urban, Alexandra; and Drees, Cornelia, "Concurrent brain-responsive and vagus nerve stimulation for treatment of drug-resistant focal epilepsy." (2022). Articles, Abstracts, and Reports. 5965.